跨部門團隊合作降低腫瘤科病人送檢遲到率

Interdepartmental Teamwork Reduces the Rate of Late for Oncology Patients Examination

10.3966/168395442015121502004

孫悅馨(Yueh-Hsin Sun)；曲幗敏(Kuo-Min Chu)；簡雅卉(Ya-Hui Chien)；李宜恬(I-Tien Lee)；王毓琪(Yu- Chi Wang)；陳美碧(Mei-Bih Chen)

送檢 ； 護送人員 ； 跨部門團隊合作 ； Patient transportation ； Transportation personnel ； Multidisciplinary approach

腫瘤護理雜誌

15卷2期（2015 / 12 / 01）

37 - 49

繁體中文

臨床上觀察到腫瘤科病人因執行化學治療後導致虛弱、免疫低下等情況，產生併發症，須接受各項檢查，常因護送檢查等待時間過久，延誤後續病人治療時間，導致病人及家屬抱怨，及生命的危害，使護理人員或護送人員產生衝突情形；經調查發現護送人員遲到率高達74.8%，平均遲到18.3分鐘。由要因分析後確立問題為：護送人員未依時間準時到達單位、檢查單位臨時通知、電腦輸入時間與檢查時間間隔≦30分鐘、護理人員準備時間≧10分鐘與病人進食或如廁等。故擬定專案目標為降低病人送檢遲到率至50%以下。解決辦法為：提早告知病人檢查接送時間，查核輸入檢查時間之正確性，敦促總務室督導主管對護送人員之監督，護理人員於檢查接送前10分鐘備妥病人用物，統一電腦輸入預約之「時間」定義，制定雙向聯繫單促進護理站與護送中心之雙向溝通與協調，制定檢查護送作業流程。於專案實施後，遲到率由74.8%降為49.6%，進步率33.7%，遲到時間減少8.1分鐘。遲到率雖達目標但仍有進步空間，故未來將持續與護送中心跨部門合作聯繫與協調，每半年統計護送人員個人的工作內容，詳加分析並調整改善作業準則，並進一步邀請檢查單位共同合作，提供病人及家屬最佳的服務品質。

We observed that patients of oncology are easy to have complications due to weakness and decreasing of immunity cause by chemotherapy, therefore, they need to take several examinations. But usually it takes too much time for escorts to finish the process which may lead to delay of therapy, complained by patient and their relatives, and the threat to patient’s life and health. Which often leads to conflicts between nurses and assisting escorts. The presented project aimed to reduce the delays in patient transportation for examinations by analyzing the factors and implementing multidisciplinary approach. We realized that 74.8% of patient arrivals were delayed, with the average delayed period of 18.3 minutes. The results of the factor analysis are as below: transportation personnel’s failure to arrive at the floor on time; unexpected notifications from the diagnostic departments; 30-minute discrepancy between the planned examination time and the time entered for transportation request; nursing preparation time required - over or under 10 minutes?, and patients not ready for transportation because of eating or restroom use, etc. Based on the factor analysis, our project goal was set to decrease the delays of patient transportation for examinations to below 50%. Proposed solutions included timely notification of patient transportation, verification of entered examination time, higher level of supervision of transportation personnel, completion of nursing preparation within 10 minutes prior to patient transportation, cohesive definition of ＂time＂ when entering the time into the computer system, establishment of two-way communication form to improve coordination between nursing station and patient transportation center, and establishment of patient transportation protocol. After implementing the project, the delay rate decreased from 74.8% to 49.6%, improved by 33.7%, and the delayed period decreased by 8.1 minutes. The goal was achieved but there is room for improvement in the delay rate. Result analysis indicated the frequent delays were associated with high turnover rate of nursing staff, unfamiliarity with patient transportation process, and elevated number of unexpected notifications. In order to provide best quality of patient care, we will continue to cooperate and coordinate with the transportation center, and adjust the multidisciplinary approach in patient transportation process.

1. Buljac-Samardzic, M.,Dekker, C. M.,Jeroen, D. H.,Kees, P.(2010).Interventions to improve team effectiveness: A systematic review.Health Policy,94(3),183-195.
2. Institute of Medicine(2001).Crossing the quality chasm: a new health system for the 21st century.Washington, D.C.:National Academy Press.
3. Joonas, K.,Wang, W. H.(2012).A research of service outcomes in Taiwan: the role of patients’ quality perceptions and wait time.Hospital Topics,90(1),1-10.
4. McMullen, M.,Netland, P. A.(2013).Wait time as a driver of overall patient satisfaction in an ophthalmology clinic.Clinical Ophthalmology,7(1),1655-1660.
5. Richards, J. D.,Harris, T.(2011).Beam meup scotty! Impact of personal wireless communication devices in the emergency department.Emergency Medicine Journal,28(1),29-32.
6. Shefrin, A. E.,Milner, R.,Goldman, R. D.(2012).Adolescent satisfaction in an urban pediatric emergency department.Pediatric Emergency Care,28(7),633-639.
7. 李選, S.,張婷, T.(2011)。以病人安全為服務導向之護理倫理議題。澄清醫護管理雜誌，7(4)，4-11。
8. 林麗華, L. H.,劉秋玉, C, Y.,吳幸芬, S. F.,伍麗珠, L. C.(2014)。降低手術銜接時間延遲率改善方案。領導護理，15(4)，92-104。
9. 紀淑靜, S. C.(2004)。人力派遣於醫療照護服務產業的運用。長期照護雜誌，8(4)，474-480。
10. 陳玉萍, Y. P.,曾振淦, C. K.,洪志宏, J. H.,曾雁明, N. M.(2011)。醫院服務品質與顧客價值對於癌患滿意度的關係探討。放射治療與腫瘤學，18(4)，287-297。
11. 黃小芬, S. F.,李徐芳, S. F.,沈永釗, Y. C.,賀倫惠, L. H.,蔡麗紅, L. H.(2011)。提升轉送中心對住院病人一般X光檢查之接送時效。長庚護理，22(4)，494-505。
12. 黃惠美, H. M.,施智源, Z. Y.,劉伯瑜, P. Y.(2012)。運用醫療團隊資源管理於感管政策的落實。感染控制雜誌，22(4)，170-174。

1. 劉詩涵,陳盈潓,陳怡蓉,許馨文,林秀貞(2019)。降低眼科住院病人轉送門診眼科檢查室之延遲率。嘉基護理，19(2)，27-40。